Brain tumours: awake craniotomy and Gamma Knife

Central nervous system tumours such as infiltrating gliomas or meningiomas demand a fine balance between maximal tumour resection and preservation of vital neural networks. Removing more is not always better if the price is permanent deficit.

For tumours in eloquent areas, neurosurgeons use awake craniotomy assisted by direct electrical cortical mapping and intraoperative MRI, confirming in real time that speech and movement remain intact. 5-ALA fluorescence further helps delineate tumour tissue.

For deep, small or unresectable lesions, stereotactic radiosurgery (Gamma Knife or CyberKnife) delivers hundreds of converging beams with sub-millimetre precision without incision, in one or a few sessions. Complications include temporary or permanent neurological deficits, reactive cerebral oedema and seizures, and in high-grade gliomas treatment continues with radiotherapy and chemotherapy.

Germany, South Korea and Israel concentrate advanced neurosurgical centres that receive cases deemed inoperable at home. The range is EUR 15,000 to 35,000, with fourteen to twenty-one day stays and the need for a companion throughout.

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